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Health Care Reform Decision

Publish Date: 7/2/2012

The U.S. Supreme Court’s decision to uphold most of the provisions of the entire Affordable Care Act, including the individual mandate that virtually all Americans buy health insurance, is still reverberating throughout the health care provider community. Despite the ongoing political clashes over the law, now that the decision is in, hospitals, industry, and insurers are moving ahead with plans to improve quality of care while reducing unnecessary health care costs. As more Americans gain health insurance, operating rooms are likely to see increases in the number of surgeries scheduled. In addition to coping with an increase in surgical volumes, perioperative nurses must also continue to provide knowledge and guidance to their institutions as health care organizations implement their plans to improve outcomes and reduce costs.

The Affordable Care Act’s emphasis on primary and preventative care, coupled with its mandate for individuals to purchase health insurance coverage, means operating room nurses could see an influx of surgery patients beginning as early as next year and continuing throughout this decade. The RAND Corporation predicts that the Affordable Care Act’s individual mandate for health insurance will result in 27 million newly insured people by 2016. As these 27 million individuals gain access to primary care, demands on operating room schedules will eventually increase. It is incumbent upon perioperative nurses to begin planning today to provide optimal outcomes for these future surgery patients.

In addition, the Court’s decision should provide momentum to state efforts to create affordable health insurance exchanges. The state-based insurance marketplaces created by the Affordable Care Act are intended to make buying health coverage easier and more affordable for individuals and small businesses by increasing competition among private insurance plans and making consumers more informed. Starting on January 1, 2014, consumers should have access to coverage through an insurance exchange in their state. If a state decides not to operate an exchange, residents should have access to insurance through a Federally-facilitated Exchange operated by the U.S. Department of Health and Human Services.

Because each state is approaching the development of exchanges differently and at different paces, it is important for perioperative nurses to learn about the formation of the exchange in their state to see how they can get involved to ensure perioperative nursing has a voice in their state’s selection of benchmark plans, determinations of governance boards and identification of essential community providers. RNFAs in particular have a large stake in state decisions concerning insurance exchanges and coverage requirements.

In addition to increasing the number of patients with health care coverage, the Court’s decision to uphold the Affordable Care Act preserves funding for CMS’s Center for Medicare and Medicaid Innovation. The Innovation Center was created by the Affordable Care Act to find new ways to pay for and deliver care that improves health while lowering costs. Much of the work of the Innovation Center has been underway and now that the decision is in, the Innovation Center will continue its mission of improving patient care and satisfaction by funding innovation projects nationwide. To view funded projects in your state, visit the Innovation Center here.

Other Affordable Care Act initiatives already underway and sustained by the Court’s decision include funding for nursing education and workforce development, including spending and grants for nurse education, quality and retention. It is important for perioperative nurses to seek out education opportunities to ensure well-trained nurses in all operating rooms, particularly because of the projected increase in patient volumes.

Regardless of political affiliation or personal experiences with implementing the Affordable Care Act, all perioperative nurses need to show leadership in this time of health care delivery transformation. As our country moves toward the laudable goals of higher quality and lower cost health care, perioperative nurses remain at the forefront of safety in our nation’s operating rooms.